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Senior services providers discuss health care changes

By Leigh Irvin lirvin@daily-times.com

Updated:
02/24/2013 09:31:23 PM MST

FARMINGTON — It could take years for the true impacts of health care reform to be measurable, but the rapidly-growing senior population will be affected by changes included in the Patient Protection and Affordable Care Act, informally known as Obamacare.

The act contains some provisions pertaining specifically to senior and long-term care. An aging baby boomer population and an expected shortage of doctors when mandatory health insurance requirements begin in 2014 underlie many of the anticipated problems.

And the ongoing problem of Medicare reimbursements that do not cover the costs of care could complicates matters.

"It's up in the air right now, and all depends on what happens with Medicare," said Rebecca Morgan, owner of Namaste, a Farmington assisted living residential facility.

"The baby boomers are still taking care of their parents, but all of the baby boomers are going to hit old age at the same time," she said. "We're sorely under-prepared for that. It's not just a lack of nursing home beds, but there are not enough doctors."

Gary Moffitt, co-owner of Basin Home Health and Hospice, and Basin Coordinated Health Care, agrees that senior care providers are holding their breath to see what will happen.

"We're all trying to evaluate precisely what the impact will be," he said.

Medicare has been covering some preventive care services for years, but the act has added free "annual wellness visits," which include yearly risk assessments and personalized prevention plans.

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This supports the law's goal of steering patients toward family practice physicians who can monitor health, prescription use, and general well-being over the long run.

Some local senior services providers, however, foresee challenges.

The San Juan Center for Independence is a local nonprofit agency designed to assist people with disabilities. It also offers seniors personal care options, such as assistance with caring for themselves in the home, as well as transitional services as seniors enter and exit nursing homes.

"One of the biggest issues is that many seniors don't take care of themselves like they used to," said the organization's executive director, Branda Parker. "They're supposed to go to the doctor once a year for their yearly physical, but many older people don't want to do that, so they can lose their benefits if they don't go."

Parker said even seniors who want annual checkups often cannot see a personal care physician due to lack of transportation, or because many doctors are not accepting new patients.

"Some doctors also don't accept Medicare, so how are the patients supposed to be seen?"

Parker pointed out that many seniors in the county come from the lower income bracket, and with the mandated insurance portion of the act kicking in January 2014, some may find themselves in a no-win situation.

"So many seniors can't afford the insurance. If they can't afford the insurance, how are they going to be able to afford the fine for not having the insurance?" she said. "I don't think the law was thought through, especially considering seniors in rural areas like ours."

The act does allow some exemptions from the mandatory insurance requirement, including for some low-income individuals.

Parker believes these issues will drive many seniors to clinics and urgent-care facilities, which again might hinder the act's goal of encouraging patients to obtain personal care physicians who can consistently monitor their health.

"Even with the law, I think we're going to be going away from being able to see the same doctor each time," Parker said.

Casey Crotty is chief executive officer for the San Juan Independent Practice Association, which manages contracting between local health care providers and insurance companies, verifies medical credentialing, and provides other support, quality control, and educational services to medical practices and patients.

Crotty agrees that the trend may be toward mid-level medical personnel, such as physician's assistants, providing the majority of care, and said we may actually see an increase in clinic-based care.

"We haven't seen it in Farmington yet, but retail clinics' staffed by mid-levels, offering longer hours and located in drug stores and other retail locations, are gaining traction in other areas," he said.

The act includes a 50% discount on prescription drugs for Medicare recipients, which will undoubtedly help seniors with the high cost of medication. But the problem with seeing different doctors at each visit is the difficulty of tracking the multiple prescriptions some seniors need.

"We had someone who was in a nursing home, and when she came out, she had four different prescriptions for Coumadin," Parker said. "She didn't even know that was wrong. If people are going to see different doctors, there's no one keeping track of these prescriptions."

Coumadin is used to lower the chance of blood clot formation and even a slight overdose can be extremely dangerous.

The Affordable Care Act also includes steps to increase the pool of trained long-term care workers and in-home assistants.

Moffitt believes there is a definite need for increased long-term care support and assistance for seniors.

"The demographics are changing, and we can't even keep up with it now," he said. "The reimbursement rate is low, and when you look at all the costs involved in providing services, plus employers having to provide health insurance for employees on top of it, it could be very detrimental for providers to continue on with these services."

Despite these possible shortcomings, like many in the family practitioner field, some senior-care providers agree that health care reform is a positive step toward addressing the growing needs of seniors in America.

"I believe that while the law is far from perfect, I'm really grateful it's on the table. We need to keep working on it without demonizing each other," said Morgan. "When we start demonizing each other, we stop the conversation, and nothing gets done."

Others, while hopeful, are taking a more cautious stance.

"The need for more home health care and hospice services is going to increase, so more access to health care and insurance is good," said Moffitt. "But can the system handle it? We'll have to wait and see what will happen."

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